scholarly journals Serum Tumor Markers in Paraneoplastic Neurologic Syndromes: A Systematic Review of Guidelines

2021 ◽  
Vol 11 ◽  
Author(s):  
Chiara Trevisiol ◽  
Ilaria Cani ◽  
Aline S. C. Fabricio ◽  
Massimo Gion ◽  
Bruno Giometto ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Tumor Markers ◽  
Dissemination And Implementation ◽  
Circulating Biomarkers ◽  
Neurologic Disorder ◽  
Onconeural Antibodies ◽  
Inappropriate Use ◽  
Literature Searches ◽  
Common Framework ◽  
Paraneoplastic Neurologic Syndromes

Purpose: Algorithms for the detection of a malignancy in patients with unclear neurologic symptoms of suspicious paraneoplastic origins are not universally applied. Frequently, circulating tumor markers (TMs) are considered a valuable tool for cancer diagnosis in patients with paraneoplastic neurologic syndromes (PNS). Our aim was to extract the recommendations on the use of TMs and onconeural antibodies (Abs) for the diagnosis of malignancies in PNS from clinical practice guidelines and put them forward as evidence in a common framework to facilitate diffusion, dissemination, and implementation.Methods: Systematic literature searches were performed for guidelines on both oncology and PNS published since 2007. Guidelines containing information and recommendations for clinical practice pertaining to the screening and diagnosis of PNS were selected. Information on circulating TMs and onconeural Abs was extracted and synthesized in consecutive steps of increasing simplification.Results: We retrieved 799 eligible guidelines on oncology for the potential presence of information on PNS but only six covered treated diagnosis or the screening of cancer in PNS, which were then selected. Seventy-nine potentially relevant guidelines on PNS were identified as eligible and 15 were selected. Synoptic tables were prepared showing that classical TMs are not recommended for the screening or the diagnosis of a malignancy in patients with a suspected PNS. Neither should onconeural Abs be considered to screen for the presence of a malignancy, although they could be helpful to define the probability of the paraneoplastic origin of a neurologic disorder.Conclusion: The present work of synthesis may be a useful tool in the diffusion, dissemination, and implementation of guideline recommendations, potentially facilitating the decrease of the inappropriate use of circulating biomarkers for cancer screening in the presence of PNS.

scholarly journals Genetic Testing for Minors: Comparison between Italian and British Guidelines

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Pamela Tozzo ◽  
Luciana Caenazzo ◽  
Daniele Rodriguez
Keyword(s):  
Clinical Practice ◽  
Genetic Testing ◽  
Ethical Issues ◽  
Social Issues ◽  
Carrier Testing ◽  
European Countries ◽  
National Guidelines ◽  
Common Framework ◽  
Professional Guidelines

Genetic testing in children raises many important ethical, legal, and social issues. One of the main concerns is the ethically inappropriate genetic testing of minors. Various European countries established professional guidelines which reflect the different countries perspectives regarding the main ethical issues involved. In this paper, we analyze the Italian and the British guidelines by highlighting differences and similarities. We discuss presymptomatic, predictive, and carrier testing because we consider them to be the more ethically problematic types of genetic testing in minors. In our opinion, national guidelines should take into account the different needs in clinical practice. At the same time, in the case of genetic testing the national and supranational protection of minors could be strengthened by approving guidelines based on a common framework of principles and values. We suggest that the Oviedo Convention could represent an example of such a common framework or, at least, it could lead to articulate it.

CHALLENGES IN CLINICAL PRACTICE OF CR MAMMOGRAPHY IN TANZANIA

2018 ◽  
Vol 184 (1) ◽  
pp. 109-115
Author(s):  
Jofrey Jackson ◽  
Wilbroad E Muhogora ◽  
Ismael N Makundi
Keyword(s):  
Clinical Practice ◽  
Staff Training ◽  
Beam Quality ◽  
Improve Patient Care ◽  
Operational Conditions ◽  
Inappropriate Use ◽  
Regulatory Guidance ◽  
Mean Glandular Dose ◽  
Oblique Projections ◽  
Improve Patient

Abstract The aim of this study was to evaluate the clinical practice of CR mammography in Tanzania. The equipment performance and operational conditions were studied; and mean glandular dose (DG) estimated to 75 women undergoing diagnosis at three mammography facilities. All mammograms during this study were reported to be useful for the intended diagnosis. The median DG for craniocaudal and mediolateral oblique projections ranged from 1.27 ± 0.18 mGy to 1.9 ± 0.27 mGy and from 1.3 ± 0.18 mGy to 1.9 ± 0.27 mGy, respectively, and were below the national regulatory guidance of 2.5 mGy. Despite this positive result, unavoidable inappropriate use of beam quality and tube loading settings which could have been through appropriate staff training and performing routine quality control were not uncommon. This work provides an insight of current operational conditions of CR in Tanzania and what strategy should be employed to this service to improve patient care in the country.

scholarly journals Introduction of new tumor marker age score in clinical practice: Validity evaluation for differentiation benign from malignant adnexal masses

2012 ◽  
Vol 59 (3) ◽  
pp. 49-56
Author(s):  
Ivana Likic-Ladjevic ◽  
Milan Terzic ◽  
Nebojsa Ladjevic ◽  
Jelena Dotlic ◽  
Igor Pilic ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Tumor Marker ◽  
Tumor Markers ◽  
Ca 125 ◽  
Benign Tumors ◽  
Tumor Type ◽  
Adnexal Masses ◽  
Combined Tumor ◽  
Adnexal Tumor ◽  
Adnexal Tumors

OBJECTIVE: The aim of the study was to examine several tumor markers and their correlation with pathohistological findings in patients with adnexal masses. METHODS: Study involved 139 patients, 84 of them with benign, 47 with malignant and 8 with borderline adnexal tumor. Levels of CA 125, CA 19-9, CEA and CA 15-3 were obtained preoperatively and assessed regarding the specific pathohistological diagnose and the patient?s age. Obtaining these results led us to divide the patient?s CA 125 levels with age and by doing that we have attained a new Tumor Marker Age score (TMA score). Results: Patients with malignant adnexal tumors had significantly higher levels of CEA (p<0.05), CA 125, CA 19-9 and CA 15-3 tumor markers (p<0.01), in comparison with patients with benign tumors. TMA score highly statistically correlate with the tumor type (benignant/malignant). CONCLUSIONS: With the increase of tumor marker levels and the patient?s age the malignant nature of adnexal tumors is more often. Results of our study highlight the importance of the use of combined tumor markers (at least CA-125 and CA 19-9) in women with adnexal masses. Those levels along with the patient?s age and new TMA score could preoperatively predict malignant nature of the tumor.

Dissosiativ identitetsforstyrrelse i utredning av barn og ungdom: Teori og kliniske utfordringer

2021 ◽  
Vol 58 (8) ◽  
pp. 672-680
Keyword(s):  
Clinical Practice ◽  
Relevant Literature ◽  
Dissociative Disorders ◽  
Cognitive Difficulties ◽  
Dissociative Symptoms ◽  
Literature Searches ◽  
Adequate Understanding ◽  
Assessment And Treatment ◽  
Trauma Model ◽  
Practice Methods

Background: Clinical practice and recent research indicate that dissociative symptoms and disorders are left unidentified and undiagnosed by health professionals. Based on a clinical case from our work setting, this article describes relevant literature regarding dissociation and dissociative disorders to add to the knowledge of the theoretical and phenomenological features of complex dissociative disorders. Further, we describe differential diagnostic challenges that may arise in clinical practice. Methods: Both systematic and non-systematic literature searches were performed. Findings: Recent research shows the Trauma model to be central to understanding dissociative disorders. Symptoms can be mistaken for cognitive difficulties, oppositional issues or other somatic symptoms. Quantitative measures, systematic observations and clinical evaluations are fundamental for identifying dissociative symptoms and disorders. Implications: There is potential for identifying and evaluating dissociative symptoms at an earlier stage. Interdisciplinary and differential diagnostic evaluations are crucial to provide adequate understanding, assessment, and treatment of these patients. Keywords: Dissociative identity disorder, dissociation, somnambulism, biopsychosocial framework, clinical practice

Big data registries in spine surgery research: the lurking dangers

2020 ◽  
pp. bmjebm-2019-111333
Author(s):  
Chad F Claus ◽  
Evan Lytle ◽  
Daniel A Carr ◽  
Doris Tong
Keyword(s):  
Big Data ◽  
Clinical Practice ◽  
Spine Surgery ◽  
Easy Access ◽  
Inappropriate Use ◽  
Number Of Patients ◽  
Surgery Research ◽  
National Databases ◽  
Proper Interpretation ◽  
Quality Evidence

Spine surgery research has improved considerably over the last few decades. Its’ most recent growth is in large part due to the mounting increase in studies conducted using national databases and registries. With easy access to a large number of patients, the benefit of these registries has become evident. However, as with any research, this type of data must be used responsibly with the appropriate strengths and limitations kept in mind. Inappropriate use of these registries continues to be a growing concern as potentially false or inaccurate conclusions can adversely impact clinical practice. It is, therefore, the author and the readers’ responsibility to acknowledge and understand the limitations of this type of data. Knowledge of methodological requirements in the use and analyses of registry data is essential to ensuring quality evidence with proper interpretation.

1997 update of recommendations for the use of tumor markers in breast and colorectal cancer. Adopted on November 7, 1997 by the American Society of Clinical Oncology.

1998 ◽  
Vol 16 (2) ◽  
pp. 793-795 ◽  
Keyword(s):  
Breast Cancer ◽  
Colorectal Cancer ◽  
Clinical Practice ◽  
Clinical Oncology ◽  
Tumor Markers ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Disease Free Survival ◽  
Research Committee ◽  
American Society

OBJECTIVE The primary objective was to update the 1996 clinical practice guidelines for the use of tumor marker tests in the prevention, screening, treatment, and surveillance of breast and colorectal cancers. These guidelines are intended for use in the care of patients outside of clinical trials. OPTIONS Six tumor markers for colorectal cancer and eight for breast cancer were considered. They could be recommended or not for routine use or for special circumstances. In addition to carcinoembryonic antigen (CEA) and cancer antigen (CA) 15-3, CA 27.29 also was considered in regard to circulatory tumor markers for breast cancer. OUTCOMES In general, the significant health outcomes identified for use in making clinical practice guidelines (overall survival, disease-free survival, quality of life, lesser toxicity, and cost effectiveness) were used. EVIDENCE A computerized literature search from 1994 to July 1997 was performed. VALUES The same values for Use, Utility, and Levels of Evidence were used by the Committee. BENEFITS, HARMS, AND COSTS The same benefit, harms, and costs were used. RECOMMENDATION No changes in any guidelines were recommended (see text). VALIDATION External review by the American Society of Clinical Oncology (ASCO) Health Services Research Committee and by ASCO Board of Directors. SPONSOR American Society of Clinical Oncology.

scholarly journals Clinical Guidelines 2.0: Translation of Tables 2 and 3 and Apendix 1 of Schünemann HJ et al. CMAJ. 2014; 186:E123-42.

2015 ◽  
Vol 28 (3) ◽  
pp. 395
Author(s):  
Guilherme Ferreira dos Santos ◽  
Pedro Correia Azevedo ◽  
António Vaz-Carneiro
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Care ◽  
Canadian Medical Association Journal ◽  
Dissemination And Implementation ◽  
Quality Literature ◽  
Intrinsic Quality ◽  
The University ◽  
Based Medicine

<p>Clinical Practice Guidelines are instruments to support decision to improve the quality of clinical care. An expert group from McMaster University (Canada) has developed - from high-quality literature sources – a guidance on the practical steps for their development, dissemination, implementation and evaluation. This is the 1st time anyone seeks to bring together in one document all information regarding the Clinical Practice Guidelines. Due to the interest of this paper, the Centre for Evidence Based Medicine at the University of Lisbon School of Medicine contacted the authors of the article and the journal where it was published (the Canadian Medical Association Journal) in order to translate the most relevant parts of the article (including the practice tables), which was agreed. This guide should be useful to those who, being interested in the development, dissemination and implementation of Clinical Practice Guidelines, want to ensure their intrinsic quality based on relevant and updated evidence.</p>

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